Journal of Neurology

, Volume 257, Issue 4, pp 533–539

An exploration of ocular fixation in Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy

  • Ralph Allen Pinnock
  • Richard Canice McGivern
  • Raeburn Forbes
  • James Mark Gibson
Original Communication


Since the basal ganglia are thought to have a role in controlling ocular fixation it is expected that patients with parkinsonian conditions would show impaired performance in fixation tasks. Our study examines ocular fixation in patients with a range of parkinsonian conditions (Idiopathic Parkinson’s Disease, Multiple System Atrophy and Progressive Supranuclear Palsy). Eye movements were recorded from 44 patients and 50 age matched control subjects during ocular fixation both with and without a visible target. The data for each patient were then characterised in terms of fixation periods and saccadic intrusions (SI). Patient groups exhibited larger and more frequent SI as well as greater displacement from the fixation target. Patients with Progressive Supranuclear Palsy exhibit larger SI than control subjects when fixation targets are visible, this difference is reversed in the absence of a fixation target. Patients with Multiple System Atrophy show increased frequency of SI both with and without a visible target. Our findings show that ocular fixation is impaired in patients with parkinsonian conditions and may prove useful as part of an oculomotor profile to aid with the differentiation of parkinsonian conditions.


Parkinsonism Fixation Eye movements 


  1. 1.
    Averbuch-Heller L, Stahl JS, Hlavin ML, Leigh RJ (1999) Square-wave jerks induced by pallidotomy in parkinsonian patients. Neurology 52(1):185–188PubMedGoogle Scholar
  2. 2.
    Bhidayasiri R, Riley DE, Somers JT, Lerner AJ, Büttner-Ennever JA, Leigh RJ (2001) Pathophysiology of slow vertical saccades in progressive supranuclear palsy. Neurology 57:2070–2077PubMedGoogle Scholar
  3. 3.
    Burman DD, Bruce CJ (1997) Suppression of task related saccdes by electrical stimulation in the primates frontal eye field. J Neurophysiol 77:2252–2267PubMedGoogle Scholar
  4. 4.
    Elidan J, Gay I, Lev S (1984) Square wave jerks: incidence, characteristic, and significance. J Otolaryngol 13(6):375–381PubMedGoogle Scholar
  5. 5.
    Fahn S, Elton R, UPDRS program members (1987) Unified Parkinsons disease rating scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB (eds) Recent developments in Parkinsons disease, vol 2. Macmillan Healthcare Information, Florham Park, NJ, pp 153–163Google Scholar
  6. 6.
    Frohman EM, Zhang H, Kramer PD, Fleckenstein J, Hawker K, Racke MK, Frohman TC (2001) MRI characteristics of the MLF in MS patients with chronic internuclear ophthalmoparesis. Neurology 57(5):762–768PubMedGoogle Scholar
  7. 7.
    Fukazawa T, Tashiro K, Hamada T, Kase M (1986) Multisystem degeneration: drugs and square wave jerks. Neurology 36:1230–1233PubMedGoogle Scholar
  8. 8.
    Herishanu YO, Sharpe JA (1981) Normal square wave jerks. Invest Opthalmol Vis Sci 20(2):268–272Google Scholar
  9. 9.
    Hikosaka O, Wurtz RH (1985) Modification of saccadic eye movements by GABA-related substances. I. Effect of muscimol and bicuculline in monkey superior colliculus. J Neurophysiol 53:266–291PubMedGoogle Scholar
  10. 10.
    Hikosaka O, Wurtz RH (1985) Modification of saccadic eye movements by GABA-related substances. II. Effects of muscimol in monkey substantia nigra pars reticulate. J Neurophysiol 53:292–308PubMedGoogle Scholar
  11. 11.
    Hughes AJ, Daniel SE, Lees AJ (2001) Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 57:1497–1499PubMedGoogle Scholar
  12. 12.
    Hughes AJ, Daniel SE, Ben-Shlomo Y, Lees AJ (2002) The accuracy of diagnosis of parkinsonian syndromes in a specialist movement disorder service. Brain 125:861–870CrossRefPubMedGoogle Scholar
  13. 13.
    Jones A, Friedland RP, Koss B, Stark L, Thompkins-Ober BA (1983) Saccadic intrusions in Alzheimer-type dementia. J Neurol 229:189–194CrossRefPubMedGoogle Scholar
  14. 14.
    Leigh RJ, Zee DS (2006) The neurology of eye movements. Oxford University Press, New YorkGoogle Scholar
  15. 15.
    Leigh RJ, Riley DE (2000) Eye movements in parkinsonism. Neurology 54(5):1018–1019PubMedGoogle Scholar
  16. 16.
    Leigh RJ, Kennard C (2004) Using saccades as a research tool in the clinical neurosciences. Brain 127:1–18CrossRefGoogle Scholar
  17. 17.
    Litvan I, Bhatia KP, Burn DJ, Goetz CG, Lang AE, McKeith I (2003) Movement Disorders Society Scientific Issues Committee report: SIC task force appraisal of clinical diagnostic criteria for parkinsonian disorders. Mov Disord 18(5):467–486CrossRefPubMedGoogle Scholar
  18. 18.
    McGivern RC, Gibson JM (2006) Characterisation of ocular fixation in humans by analysis of saccadic intrusions and fixation periods: a pragmatic approach. Vision Res 46:3741–3747CrossRefGoogle Scholar
  19. 19.
    Melville-Jones G, DeJong JD (1971) Dynamic characteristics of saccadic eye movements in Parkinson’s disease. Exp Neurol 31:17–31CrossRefGoogle Scholar
  20. 20.
    Michell AW, Xu Z, Fritz D, Lewis SJG, Foltynie T, Williams-Gray CH, Robbins TW, Carpenter RHS, Barker RA (2006) Saccadic latency distributions in Parkinson’s disease and the effects of l-Dopa. Exp Brain Res 174(1):7–18CrossRefPubMedGoogle Scholar
  21. 21.
    Munoz DP, Wurtz RH (1993) Fixation cells in monkey superior colliculus. II. Reversible activation and deactivation. J Neurophysiol 70:576–589PubMedGoogle Scholar
  22. 22.
    Mutch WJ, Dingwall-Fordyce I, Downie AW, Paterson JG, Roy SK (1986) Parkinson’s disease in a Scottish city. BMJ 292:534–536CrossRefPubMedGoogle Scholar
  23. 23.
    Ohtsuka K, Mukuno K, Ukai K, Ishikawa S (1986) The origin of square wave jerks: conditions of fixation and microsaccades. Jpn J Ophthalmol 30:209–215PubMedGoogle Scholar
  24. 24.
    Rascol O, Sabatini U, Simonetta-Moreau M, Montastruc JL, Rascol A, Clanet M (1991) Square wave jerks in parkinsonian syndromes. J Neurol Neurosurg Psychiatry 54:599–602CrossRefPubMedGoogle Scholar
  25. 25.
    Rivaud-Péchoux S, Vidailhet M, Gallouedec G, Litvan I, Gaymard B, Pierrot-Deseilligny C (2000) Longitudinal ocular motor study in corticobasal degeneration and progressive supranuclear palsy. Neurology 54:1029–1032PubMedGoogle Scholar
  26. 26.
    Salvucci DD, Goldberg JH (2000) Identifying fixations and saccades in eye-tracking protocols. Proceedings of the eye tracking research and applications symposium, pp 71–78Google Scholar
  27. 27.
    Scherfler C, Schwarz J, Antonini A, Grosset D, Valldeoriola F, Marek K, Oertel W, Tolosa E, Lees AJ, Poewe W (2007) Role of DAT-SPECT in the diagnostic work up of parkinsonism. Mov Disord 22(9):1229–1238CrossRefPubMedGoogle Scholar
  28. 28.
    Schlag-Rey M, Schlag J, Dassonville P (1992) How the frontal eye field can impose a saccade goal on superior colliculus neurons. J Neurophysiol 67(4):1003–1005PubMedGoogle Scholar
  29. 29.
    Schrag A, Ben-Shlomo Y, Quinn NP (1999) Prevalence of progressive supranuclear palsy and multiple system atrophy: a cross-sectional study. Lancet 354:1771–1775CrossRefPubMedGoogle Scholar
  30. 30.
    Schrag A, Ben-Shlomo Y, Quinn NP (2000) Cross sectional prevalence survey of idiopathic Parkinson’s disease and parkinsonism in London. Br Med J 321:21–22CrossRefGoogle Scholar
  31. 31.
    Schrag A, Ben-Shlomo Y, Quinn N (2002) How valid is the clinical diagnosis of Parkinson’s disease in the community? J Neurol Neurosurg Psychiatry 73:529–534CrossRefPubMedGoogle Scholar
  32. 32.
    Shallo-Hoffmann J, Petersen J, Muhlendyck H (1989) How normal are ‘‘normal’’ square wave jerks? Invest Opthalmol Vis Sci 30(5):1009–1011Google Scholar
  33. 33.
    Shallo-Hoffmann J, Sendler B, Muhlendyck H (1990) Normal square wave jerks in differing age groups. Invest Ophthalmol Vis Sci 31:1649–1652PubMedGoogle Scholar
  34. 34.
    Sharpe JA, Herishanu YO, White OB (1982) Cerebral square wave jerks. Neurology 32:57–62PubMedGoogle Scholar
  35. 35.
    Troost BT, Daroff RB (1977) The ocular motor defects in progressive supranuclear palsy. Ann Neurol 2(5):397–403CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ralph Allen Pinnock
    • 1
  • Richard Canice McGivern
    • 1
  • Raeburn Forbes
    • 2
  • James Mark Gibson
    • 3
  1. 1.Northern Ireland Regional Medical Physics AgencyRoyal Victoria HospitalBelfastNorthern Ireland, UK
  2. 2.Department of NeurologyCraigavon Area HospitalPortadownNorthern Ireland, UK
  3. 3.Department of NeurologyRoyal Victoria HospitalBelfastNorthern Ireland, UK

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